Child and Adolescent All-Cause Mortality in the United States vs Peer Nations: 1935–2023

BACKGROUND: Children in the United States experience higher all-cause mortality than high-income peer nations, but the timing, durability, and age and sex contributions to this gap remain unclear. OBJECTIVES: To characterize the timing, persistence, and age- and sex-specific patterns of the US child and adolescent mortality disadvantage relative to peer nations. METHODS: Time-series comparison using vital statistics from the Human Mortality Database (1935-2023), comparing all-cause mortality among those aged 0 to 19 years in the United States vs those living in 13 high-income peer nations from the Organisation for Economic Co-operation and Development (OECD). We estimated mortality rates, rate ratios (RRs), annual percent change (APC), and annual excess US deaths. RESULTS: All-cause mortality declined 89.0% in the United States (477.6 to 52.4 per 100 000) from 1935 to 2023, compared with 96.6% in OECD13 (785.1 to 26.9 per 100 000). US mortality crossed over OECD13 in 1975 and remained higher thereafter. By 2023, the US disadvantage was largest among those aged 15 to 19 years (RR 2.9). From 2006 to 2023, APC was -1.2% (95% CI -1.7% to -0.6%) in the United States vs -2.3% (95% CI -2.7% to -2.0%) in OECD13. In 2023, those aged 15 to 19 years accounted for 40.4% of excess deaths, with male individuals contributing 30.6%. CONCLUSIONS: The US child and adolescent mortality disadvantage dates to the mid-1970s and has persisted for 5 decades, with the gap now concentrated among older male adolescents.